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  1. Beenthere2Hippie
    View attachment 49582 Swaddled in soft hospital blankets, Lexi is 2 weeks old and weighs 6 pounds. She's been at Women and Infants Hospital in Providence, Rhode Island since she was born, and is experiencing symptoms of opioid withdrawal. Her mother took methadone to wean herself from heroin when she got pregnant, just as doctors advised. But now the hospital team has to wean newborn Lexi from the methadone.

    As rates of opioid addiction have continued to climb in the U.S., the number of babies born with neonatal abstinence syndrome has gone up, too — by five-fold from 2000 to 2012, according to the National Institute of Drug Abuse. It can be a painful way to enter the world, abruptly cut off from the powerful drug in the mother's system. The baby is usually born with some level of circulating opioids. As drug levels decline in the first 72 hours, various withdrawal symptoms may appear — such as trembling, vomiting, diarrhea or seizures.

    At some point, if symptoms mount in number or severity, doctors will begin giving medication to help ease them. The idea is to give the baby just enough opioid to reduce those symptoms, and then slowly, over days or weeks, decrease that dose to zero. A doctor comes to check on Lexi and her mother, Carrie. To protect her family's privacy, Carrie asked us not to use the family name.

    "So, hi, Peanut!" the doctor says to the baby. "Any concerns?" she asks Carrie.

    "Coming down has been catching up with her," says Carrie.

    "Do you feel like she's jittery?" the doctor asks.

    "She didn't want to be put down last night — like [she had] the shakes," Carrie says.

    Lexi has neonatal abstinence syndrome, and has been getting methadone treatments for it. She is getting better — most babies do — but even with treatment, she's had tremors, diarrhea, and she's cried and cried. Her little arms and legs tighten up, her fingers and toes clenched. She's been feverish, her mother says.

    "I know what she's feeling," Carrie says. "And that is the worst part."

    Carrie was addicted to heroin herself and knows withdrawal is miserable. She's been off heroin — with help from methadone — since she found out she was pregnant, she says. The small dose of methadone keeps a low level of opioid in her system so she doesn't go into withdrawal, but it doesn't get her high. For Carrie and thousands like her, methadone is a lifesaver — helping them quit a heroin or oxycodone or other opioid habit for good. But getting pregnant posed a dilemma: If Carrie stopped taking opioids altogether, she risked relapse or miscarriage. Yet, if she continued to take any opioid — including methadone — there would be a 60 to 80 percent chance that her baby would be born with neonatal abstinence syndrome, the doctors told her.

    "It's hard to watch, as her mother," Carrie says, "because you're helpless and there's really nothing you can do. You are a lot of the reason why she's going through what she's going through."

    Babies going through withdrawal spend weeks — even months — in hospital nurseries like this one. "Their cry is very different," says Cindy Robin, a registered nurse at the Providence hospital, who has been caring for mothers and newborns for more than 30 years. "It's a more distressed cry," she says, "and it really pulls at your heartstrings to have to listen to them." Robin says babies with mild symptoms of the withdrawal syndrome will sneeze and sniffle. They have trouble settling down. Babies who have a more severe case can have seizures and dangerously high fevers. Robin says nurses have to dim the lights, and swaddle the newborns tightly to help keep them calm.

    "They just need to be held in a nice, quiet spot," she says. "We have nice quiet music playing, and try to keep them as comfortable as possible."

    Nurses with special training check on the babies every couple of hours.

    "So these are the things that we look for ... and what we teach the parents," she says: "Is the baby crying excessively? Is it a high pitched cry? Is it just a continuous cry? How do they sleep after they eat?"

    Medication, which is gradually decreased, can help ease this constellation of symptoms.

    "The American Academy of Pediatrics and others recommend an opioid for the babies, because you're giving them back what they're withdrawing from," explains Dr. Jonathan Davis, a neonatologist and chief of newborn medicine at Tufts' Medical Center. "Morphine and methadone are the two most common."

    But Davis says no one's really done the research to figure out which drug works better for babies, and doctors are left to figure that out by trial and error, case by case. Though the Food and Drug Administration hasn't officially approved morphine or methadone for use in newborns, doctors prescribe these drugs to the children anyway, in smaller doses than they give adults. "As I spoke to people around the country, everyone would have their own approach and a very different way of treating these babies," Davis says. "And we thought that quite odd."

    So he and a colleague, Brown University developmental psychologist Barry Lester, have launched a major study to sort out what works best. The two are hoping to enroll 180 babies in their double-blind, randomized, controlled trial — no one will know which newborns are getting methadone, and which are getting morphine, for example, until the study's end. And they're taking the research further: No study yet has looked at the long-term effects of the drugs, so Davis and Lester will continue to follow-up with measures of cognitive and physical development until the children are 18 months old.

    "It may be," Davis says, "that one agent is safer short-term, but when we look longer-term it may actually be more dangerous." Teasing out long-term effects of a drug isn't easy, Lester says; many factors can influence a baby's development. If you're drug-exposed and you're growing up in an inadequate environment — which may not be poverty, it may be inadequate parenting — that's a double whammy," he says. "Those are going to be your worst case scenarios."

    Despite many remaining unknowns, doctors have consistently found that treatment with morphine or methadone enables most babies to get through withdrawal in about six to eight weeks. "It can be heartbreaking," says Robin, who has helped shepherd many kids through dark days. "But at the end, it is also rewarding," she says, "because you see them get better and you see them go home."

    This story is first in our four-part series Treating the Tiniest Opioid Patients, a collaboration produced by NPR's National & Science Desks, local member stations and Kaiser Health News.



    By Kristen Gorlay - NPR/March 25, 2016
    http://www.npr.org/sections/health-...ny-opioid-patients-need-help-easing-into-life
    Newshawk Crew

    Author Bio

    Beenthere2Hippie
    BT2H is a retired news editor and writer from the NYC area who, for health reasons, retired to a southern US state early, and where BT2H continues to write and to post drug-related news to DF.

Comments

  1. vervain
    Pretty decent article, I look forward to checking out the following 3 parts. I know some of the basics about mitigating opiate dependency in infants but nothing in detail.

    What a fucking way to enter the world. I'm interested in hearing any studies about long-term effects - the human body is developing at such an amazing rate during the 1st year of life, I know firsthand how withdrawals make things go utterly haywire, you'd think there have got to be some repercussions in that development.
  2. Beenthere2Hippie
    Facing Pregnancy, Addicted to Opiates

    [IMGR=white]https://drugs-forum.com/forum/attachment.php?attachmentid=49647&stc=1&d=1459187276[/IMGR]Amanda Hensley started abusing prescription painkillers when she was just a teenager. For years, she managed to function and hold down jobs. She even quit opioids for a while when she was pregnant with her now 4-year-old son. But she relapsed.

    Hensley says she preferred drugs like Percocet and morphine, but opted for heroin when she was short on cash. By the time she discovered she was pregnant last year, she couldn't quit. "It was just one thing after another, you know — I was sick with morning sickness or sick from using," says Hensley, who is 25 and lives in Cleveland. "Either I was puking from morning sickness or I was puking from being high. That's kind of how I was able to hide it for a while." Hensley says she was ashamed and hurt, and she wanted to stop using but didn't know how. She had friends who would help her find drugs — even after they found out she was pregnant.

    Finding help to get clean and protect her child proved much more difficult. The number of people dependent on opioids is increasing, and that includes women of child-bearing age, like Hensley. Researchers estimate that a baby was born dependent on opioids every 25 minutes in 2012, the most recent year for which data are available. By the time Hensley was about six months pregnant, she was living on couches, estranged from her mother and her baby's father, Tyrell Shepherd. Her son went to live with her mother.

    That's when Hensley reached out for help. One moment, she dialed to get her fix. The next, she called hospitals and clinics. "Nobody wants to touch a pregnant woman with an addiction issue," she says.

    Shepherd wasn't happy when he realized Hensley was taking opioids while pregnant. "If you don't care about yourself," he says, "have enough common decency to care about the baby you're carrying. Be adult. Own up to what it is you're doing and take care of business. Regardless of how bad you're going to feel, there's a baby that didn't ask to be there." After she was rejected by two hospitals and several clinics, Hensley let herself go into withdrawal and then went to the emergency department of MetroHealth System, Cleveland's safety-net hospital. Under the auspices of a state-supported program, Hensley was prescribed Subutex — an opioid-replacement drug that has helped her recover.

    Her baby girl, Valencia, was born three months later. Mom and baby had their own room at the hospital, where nurses encouraged snuggling and breastfeeding. The nurses were also on hand to drop liquid morphine into Valencia's mouth when her legs started shaking and her screams turned frantically high-pitched — the baby, too, had to be slowly weaned off of opioids. Hensley cries as she remembers those early days: "She wouldn't latch on — we couldn't get her to feed. I couldn't get her to stop crying. She was very fussy, and I realized, I did that to her. I took her choice away. And that's one thing I still need to work through, because I haven't forgiven myself for that." Hensley hasn't used opioids in nine months, and Valencia is now about 6 months old. She has chubby baby cheeks and clear brown eyes as big as saucers.

    During a recent visit, Valencia kept cooing and smiling — especially when her mother was nearby. "She started saying mama," Hensley says. "So now, at night when she wakes up, that's what I hear: 'Mama, ma, ma, mama.' " Doctors are trying to slowly wean Lexi from her dependence on methadone. She's just 2 weeks old. Under a doctor's advice, her mom took methadone while pregnant, to help kick a heroin habit. It's been a journey. Hensley says only within the past few months has she stopped having dreams about using opioids.

    Most physicians who specialize in addiction treatment agree that Hensley and her baby received the appropriate care. According to the American Congress of Obstetricians and Gynecologists, women who are pregnant should have medically assisted therapy that at least temporarily replaces the opioids they are using with drugs that are more stable, like methadone. Withdrawal should be discouraged during pregnancy if medically assisted therapy is available.

    Quitting opioids cold turkey is dangerous for the infant and could increase the risk of preterm labor or fetal death. Dr. Stephen Patrick, a neonatologist at Vanderbilt University's School of Medicine, says the medical community really needs to focus on providing access to medically assisted care for substance abuse. "I think it's time for us to reshape how we view addiction in the United States," he says. "It is a medical condition — it is not a moral failing." Patrick has seen firsthand how difficult it is for women to find this medical help. At Vanderbilt and in other communities he has visited around the U.S., he says, he's seen women travel for hours to receive treatments for opioid-use disorder. It's particularly a problem in rural communities.

    Dr. Jennifer Bailit, at MetroHealth, directs the mother's program that helped Hensley, and was Hensley's obstetrician. It's a tough problem to tackle, Bailit says. "These are difficult patients. They are complicated and they have complex social needs," Bailit says. "Many practitioners are just not equipped to deal with the breadth and depth of the kind of issues that come with them."

    In the past few years, MetroHealth has become a go-to place for pregnant women in Northeast Ohio, treating more and more patients. The hospital cared for a handful of pregnant women with opioid addiction in 2002. Last year, it saw 160 women, and many of them traveled some distance to reach the facility. In addition to the sort of opioid replacement therapy that Hensley received, the hospital has a whole package of services to support mothers before and after the baby is born. The hospital assigned Hensley a social worker, and set her up with intense outpatient therapy — three days a week for six months. Hensley still checks in with a doctor at the hospital once a month to get her medications.

    The support has helped the whole family recover. Valencia is hitting all her developmental milestones — like rolling over. And Shepherd has really taken to being a dad, regularly feeding the baby, changing diapers and creating silly noises to make her laugh. Hensley and Shepherd have picked out their wedding rings and have begun discussing where to have the ceremony. Hensley has also gone back to cosmetology school, and the couple is talking about when they can bring Hensley's older son home.

    This story is third in our four-part series Treating the Tiniest Opioid Patients, produced by NPR's National and Science desks, local member stations and Kaiser Health News.



    By Sarah Jane Tribble - NPR/March 28, 2016
    http://www.npr.org/sections/health-...-and-addicted-the-tough-road-to-family-health
    Newshawk Crew
  3. Beenthere2Hippie
    Hospitals Rethinking Role of Moms in Their Baby's Opiate Addiction

    [IMGL=white]https://drugs-forum.com/forum/attachment.php?attachmentid=49648&stc=1&d=1459188100[/IMGL]Carolyn Rossi has been a registered nurse for 27 years, and she's been fiercely protective of infants in her intensive care unit — babies born too soon, babies born with physical and cognitive abnormalities and, increasingly, babies born dependent on opioids.

    As clinical manager of the nurseries at the Hospital of Central Connecticut, Rossi works in the neonatal intensive care unit. Like many hospitals across the country, the facility near Hartford has seen a dramatic rise in recent years in the number of babies born with neonatal abstinence syndrome. The National Institute of Drug Abuse reports that more than 21,000 infants born in the U.S. in 2012 (the most recent year for which data are available) experienced symptoms of opioid withdrawal. The hospital says each such baby in its care costs roughly $50,000 to treat.

    These fragile and fitful newborns present new challenges for hospitals. Some research suggests the children do best when they can be held for hours at a time, preferably by their mothers, in quiet, private rooms, as they go through the process of being weaned off the drugs. But delivering care that way requires changing the attitudes of many doctors and nurses about addiction.

    Rossi, for example, says her initial training in the best ways to care for newborns in withdrawal was very different from what the research now suggests. "You know, we looked at it like, 'They are drug addicts and the baby is born a drug addict and we're trying to protect the baby from the mother,' " Rossi says. "Like we were going to cure the baby, but not cure the mother and the family. So it was a lot about taking babies away from moms."

    That turns out not to be a useful strategy if you're hoping to engage the help and support of a mother who already feels stigmatized by her drug habit, says Kate Sims, who directs women's and children's services at the hospital. "She's feeling guilt herself," Sims says. "And then [she] comes in here and, unfortunately, as best as we are as providers and nurses, we're also judgmental. And so it's felt." Doctors are trying to slowly wean Lexi from her dependence on methadone. She's just 2 weeks old. Under a doctor's advice, her mom took methadone while pregnant, to help kick a heroin habit.

    A lack of trust between mother and a nurse makes treating the baby even harder, Sims says. So the hospital is now trying to make sure everyone in patient care sees the addicted mother first as a mom. In some cases that means getting care providers to understand that addiction isn't a moral failure, and that many people who are addicted come from a lifetime of trauma. Rossi says it's been hard for nurses who have been trained to be baby specialists to become mom specialists, too. "It's a big culture change for me personally, and I know for the NICU nurses that are in here," she says. "You really do believe you're doing the right thing until something like this comes along."

    The hospital's approach to caring for these infants is changing, in other ways, too. Dr. Annmarie Golioto, chief of pediatrics and the head of the hospital's nursery, says a bright, loud and bustling intensive care unit is a hard environment for a baby going through withdrawal. So she's gotten approval to use a few rooms just outside the intensive care unit as a quiet, monitored space for a baby and mother to stay for as long as the baby needs it. "We've had to figure out: 'How can we use our rooms differently?' " says Golioto. "How can we use our space differently? And how we can partner with mom differently to have that relationship with her, to say, 'We expect you to stay here with your baby and take care of the baby after you've been discharged.' "

    Golioto hopes the new setting will shorten recovery times for the children and decrease the amount of morphine a baby needs to ease withdrawal. She's also hopeful these moves will inspire some mothers to think differently about their newborns. "The thinking was, 'My baby is being taken care of. There are nurses there. There are doctors there. I don't need to be here. They're getting everything they need,' " says Golioto. "We're trying to change the thinking — 'no, they're not getting everything they need if you're not here. Because they need you.' "

    Rossi says she recognized the value in this new nursing approach the very first time she saw it in action. It was last December, she recalls. Rossi gave a mother a hospital room to stay in for more than a month while her baby went through withdrawal. "She was just thrilled," Rossi says. Though the mother couldn't be at the hospital 24/7, "she was here as much as she could be," the nurse says, "and just knowing that she had the flexibility helped me understand that she is a mom. She is a great mom. She wants to be a better mom."

    Nearly every aspect of the opioid epidemic worsened in 2014, according to the federal government's latest figures. And even though the Hospital of Central Connecticut's programs are just a few months old, health care workers there hope the changes they've made in their culture of care will, at the very least, give vulnerable moms and babies a better start.

    This story is part of a four-part series Treating the Tiniest Opioid Patients, a collaboration produced by NPR's National & Science Desks, local member stations and Kaiser Health News.



    By Jeff Cohen - NPR/March 26, 2016
    http://www.npr.org/sections/health-...ooked-on-opioids-hospitals-rethink-mom-s-role
    Newshawk Crew
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